Merkel Susanne, Schellerer Vera S, Wein Axel, Semrau Sabine, Geppert Carol, Göhl Jonas, Hohenberger Werner, Weber Klaus, Grützmann Robert
Department of Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
Department of Surgery, University Hospital Erlangen, Krankenhausstr. 12, 91054, Erlangen, Germany.
Int J Colorectal Dis. 2018 Sep;33(9):1215-1223. doi: 10.1007/s00384-018-3098-3. Epub 2018 Jun 18.
The aim of our study was to compare the characteristics and prognosis between right- and left-sided metastatic colorectal carcinomas.
Data from 937 patients with stage IV colorectal carcinomas (synchronous distant metastasis) who had a resection of the primary tumour between 1985 and 2014 were analysed. Carcinomas in the caecum to transverse colon were defined as right-sided (n = 250; 26.7%). They were compared to tumours located from the splenic flexure to the rectum categorised as left-sided (n = 687; 73.3%).
In right-sided carcinomas, we observed significantly more female patients (50.8 vs 36.2%; p < 0.001), more unfavourable histological types (24.0 vs 8.6%; p < 0.001), more M1c carcinomas (metastases to the peritoneum ± others; 32.0 vs 14.4%; p < 0.001) and more emergencies (11.6 vs 7.1%; p = 0.029), while multimodal treatment was utilised in fewer patients (51.6 vs 63.8%; p = 0.001) and curative resections were less frequently (24.1 vs 35.4%; p = 0.002). Prognosis was significantly worse in patients with right-sided carcinomas (2-year-survival 27.2 vs 44.6%, p < 0.01). This difference was more pronounced after R2 resection (15.3 vs 29.7%; p < 0.001), than after macroscopic curative resection (2-year-survival 63.9 vs 71.9%; p = 0.106). In multivariate Cox regression analysis, tumour site was found to be an independent prognostic factor for overall survival (HR 1.2; 95% CI 1.0-1.5; p = 0.012). During the three 10-year periods, the prognosis improved equally in patients with right- and left-sided carcinomas, while the differences in survival remained identical.
In a surgical patient cohort undergoing primary tumour resection, significant differences in prognosis were observed between patients with metastatic right- and left-sided colorectal carcinomas.
本研究旨在比较右半侧和左半侧转移性结直肠癌的特征及预后。
分析了1985年至2014年间937例IV期结直肠癌（同时性远处转移）患者的数据，这些患者均接受了原发肿瘤切除术。盲肠至横结肠的癌肿定义为右半侧（n = 250；26.7%），并与脾曲至直肠的肿瘤（定义为左半侧，n = 687；73.3%）进行比较。
在右半侧癌肿患者中，女性患者显著更多（50.8%对36.2%；p < 0.001），组织学类型更差（24.0%对8.6%；p < 0.001），M1c期癌肿（转移至腹膜±其他部位；32.0%对14.4%；p < 0.001）更多，急诊情况更多（11.6%对7.1%；p = 0.029），而接受多模式治疗的患者较少（51.6%对63.8%；p = 0.001），根治性切除的频率更低（24.1%对35.4%；p = 0.002）。右半侧癌肿患者的预后明显更差（2年生存率27.2%对44.6%，p < 0.01）。这种差异在R2切除术后（15.3%对29.7%；p < 0.001）比在肉眼根治性切除术后（2年生存率63.9%对71.9%；p = 0.106）更为明显。在多变量Cox回归分析中，肿瘤部位被发现是总生存的独立预后因素（HR 1.2；95%CI 1.0 - 1.5；p = 0.012）。在三个10年期间，右半侧和左半侧癌肿患者的预后均同等改善，而生存差异保持不变。
在接受原发肿瘤切除的手术患者队列中，转移性右半侧和左半侧结直肠癌患者的预后存在显著差异。
